<p> 1675 Fairgrounds Rd., Salem, Oregon, 97303 * 503-363-4588 E-mail: [email protected] * WEB page: www.MercyCenters.org </p><p>Member registration/update Form</p><p>Make copies and distribute.!. “We are many and they are few !” For awfully cheap Yearly dues of $50, You get.!.> Monthly Newsletter, Membership card, Quarterly reports and Monthly schedule updates. Notification of events (You won’t hear about ‘em in the Oregonian!). Also, we can promote your Biz! Ask about our Biz Member plan. ------Please help us update our files. Enter in all fields where possible. Fill in with any changes to your Mailing Address. If there is no change to a fields, leave blank.</p><p>Name: >______<</p><p>Addr: >______<</p><p>City, St, Zip: >______<>______<>______<</p><p>Country (if not US): >______< Voting District, Precinct (if known): >______<</p><p>Phone#(s): >______< eMail addr: >______<</p><p>WEBsite addr: >______<</p><p>Membership Date:>______< Our last contact with you: >______< Dues: >______< to make you current to: >______< ------</p><p>BUSINESS; Own/operate a Bus. (Y/N): >___< Entry in the CannaBiz Business Registry ?: >___< do you have a Biz Card?: > ___ <</p><p>Biz Name, Motto: >______<</p><p>Type of Biz, Product Line/s : >______<</p><p>------[___] Collect petition signatures and register voters. [___] Transport volunteers & materials to/from events..</p><p>[___] Make phone calls. [___] Coordinate petitioning in your area..</p><p>[___] Office & mailing help. [___] Other: ______<</p><p>AREA/s (of expertise; “I have a truck”, “does Artwork”, “Petitioning”): ______</p><p>______<</p><p>INTERESTs (sports, band!, Associations you belong to, etc.): >______<</p><p>------NOTE: This information is only for non-commercial political use, it will not be sold or distributed to anyone else for any other purpose.</p><p>“Don’t sign me up as a member, but keep me posted on this issue !”:>_____< ( Please fill out at least one contact point {Phone#, Email addr, someway TO keep you posted } in the section above ... ! ) HELP US! PLEASE FILL OUT COMMENTs ON BACK!</p>